Windward HEALTH Summer 2018
INSIDE THIS ISSUE Insert: Patients share why AH Castle is their top choice for health care Page 2: AH Castle cares about patients’ pain—and opioid safety On April 8, Adventist Health Castle joined the “Best of the Best” in Baltimore, Maryland, to accept the Malcolm Baldrige National Quality Award. See back cover.
Phyllis O'Donoghue, and granddaughter, Rose. See the insert to learn more about why Phyllis chose AH Castle.
CASTLE NEWS
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Achieving excellence
AH Castle puts patients first—and it shows AH Castle receives “A” grade from Leapfrog Group
10 steps to safer pain control Adventist Health Castle implements Pain and Opioid Stewardship Program Opioid medications are the gold standard for the treatment of pain—a major public health concern. Pain costs $635 billion dollars per year for treatment and lost productivity. However, gaps remain in the quality and safety of pain management in hospitals. Over-reliance on opioid-based therapies has led to significant adverse events and a nationwide epidemic of opioid misuse. To better manage pain and ensure that our patients live healthier, more productive lives, AH Castle has created an Opioid Stewardship Team consisting of members from our nursing, pharmacy, physician, case management, physical therapy, QI and risk staff. The team’s task is to review and implement these top 10 strategies from Premier Safety Institute 2017 to prevent opioid-related adverse events.
A pathway to safety 1. Designate a leader/team responsible for pain management and safe opioid prescribing across the continuum of care and ensure availability of pain management experts to help providers with opioid conversion and dosing. 2. Educate and promote use of multimodal pain treatment, including nonopioid medications; nerve blocks; and alternative modalities, such as physical relaxation. 3. Educate staff at all levels and provide resources on safe opioid use, including
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pain assessment and management, the risks associated with opioids (adverse drug reactions such as respiratory depression), and potential risks of physical dependence and addiction. 4. Ensure that oxygen and reversal agents are available wherever opioids are administered. 5. Assess patients using standardized tools on admission for pain or risk of pain based on diagnosis, planned treatments or procedures, and risks for respiratory depression. 6. Educate patients on pain management treatment, including realistic expectations and goals for pain reduction, and risks related to opioid use. 7. Use technology to support safe opioid use through decision support, alert systems in the electronic medical record, and continuous electronic monitoring during use of patientcontrolled analgesia (PCA) devices. 8. Collect data on pain assessment and management—including type and effectiveness of pain interventions and timing of reassessments—investigate potential misuse—including adverse events, use of high doses, and duration of opioid prescriptions—and assist prescribers and pharmacists with access to prescription drug monitoring programs. 9. Provide written and oral education to patients and caregivers on safe opioid use, including risks, side effects, potential for sedation, danger of use in combination with alcohol or sedating drugs, and safe storage and disposal at home. 10. Establish clear procedures for evaluating and addressing suspected and identified instances of drug diversion. Through implementing the Pain and Opioid Stewardship Program, AH Castle is continuously working to establish safe and effective pain management for our patients.
The Leapfrog Group recently announced the spring 2018 Leapfrog Hospital Safety Grades. Of the approximately 2,500 hospitals graded, Adventist Health Castle was among the 30 percent that earned an “A” grade. The biannual grading assigns letter grades to general acute-care hospitals in the U.S., and is the nation’s only rating focused entirely on errors, accidents, injuries and infections—which collectively are the third leading cause of death in the United States. The Leapfrog Hospital Safety Grade is calculated by top patient safety experts, peer-reviewed, fully transparent and free to the public. It is updated every six months, once in the fall and once in the spring.
AH Castle recognized with Outstanding Patient Experience Award™ Healthgrades has announced that Castle has received the 2018 Outstanding Patient Experience Award™. This award recognizes hospitals that provide an overall outstanding patient experience. Scoring is based on Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) patient survey data from the Centers for Medicare and Medicaid Services (CMS). Hospitals that achieved this award: Continuously monitored trends in what patients find important. Delivered superior patient care experiences during hospital stays. Outperformed their peers, based on patient feedback. Quality ratings have a profound effect on consumers. In a world of everexpanding consumer choice, patients rely on objective information like Healthgrades quality ratings to make confident health care decisions— including choosing a hospital.
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AH Castle receives 2018 Women’s Choice Award® as one of America’s 100 Best Hospitals for Patient Experience Castle has been named one of America’s 100 Best Hospitals for Patient Experience by the Women’s Choice Award®. The award signifies that Castle has been ranked within the top 100 hospitals of similar size based on number of beds. The Women’s Choice Award collects the data for the following HCAHPS survey measures and uses a weighted average to award the best hospitals for patient experience: Effective communication with nurses and doctors. Responsiveness to requests for help. Pain management. Explanation about medications before being administered. Bathroom and room cleanliness. Patient recommendation rating. According to the Agency for Healthcare Research and Quality, good patient experience positively correlates to disease management, adherence to treatment plans and health outcomes. AH Castle is one of 400 award recipients that have met the highest standards for patient experience in the U.S. by the Women’s Choice Award.
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Our patients’ Exceptional care by exceptionally caring people
In January, Kimberly Jones, a self-employed kitchen and bath designer, felt a burst of pain in her heart t hat eventually sent her to Adventist Health Castle for emergency open heart surgery.
“The entire staff, from the surgeon to the nurses to the rehab staff was unbelievably caring and nice during a stressful time,” says Kimberly’s husband, Chris. “I am so thankful to them. They, as a group, saved my wife’s life. We are forever grateful.” Sometimes you may not be able to choose your health care provider, but when you can, find out in this issue why you should choose Castle.
Life has its miracles ON JAN. 16, two weeks before her 39th birthday, Kimberly Jones started her morning like most other weekdays: helping her two children get ready for school and packing their lunches. By 9 a.m. she’d dropped off the kids and was having coffee with her mother while preparing for her work day as a selfemployed kitchen and bath designer. Then she felt a bad pain in her jaw. It traveled down her neck until she felt a burst of pain in her heart. Since Jones had always been physically active and never had any serious health concerns, she dismissed her mother’s suggestion to go to an emergency room, expecting the pain to subside. When the pain persisted, she agreed to go to an urgent care clinic. Finding her blood pressure was dangerously low, the clinic called an ambulance to take her to the nearest emergency department—at AH Castle. After 3½ hours of tests, including an EKG and stress test, the medical team couldn’t identify the cause of Kimberly’s pain. She was feeling worse
Kimberly Jones
than when she arrived, and she had a gut feeling that something wasn’t right. She recalled a friend who experienced similar symptoms and died within a day. “Isn’t there something else we can do?” she asked. A CT scan found the problem: an aortic dissection caused by a severe tear in the wall of the major artery that carries blood out of the heart. The tear allowed blood to flow between layers of the blood vessel wall, leading to decreased blood flow and a bulge (aneurism) in the aorta. Henry Louie, MD, a cardiothoracic surgeon, performed emergency openheart surgery to repair the artery. He also put in a new, mechanical valve to replace the damaged one. “It was not the normal day I was expecting,” Jones recalls, but she can’t say enough good things about Dr. Louie. “He was amazing. “He really was on top of everything and gave me so much ease.” “The entire staff, from the nurses to the Rehab staff, were unbelievably
caring and nice during a stressful time,” says Jones’ husband, Chris. “I am so thankful for them…They as a group saved my wife’s life. We are forever grateful.”
A speedy recovery Following her surgery, Jones’ goal was to get home as soon as possible. Her young age and physical fitness helped speed up her recovery—she was out of the hospital in less than a week. After four weeks, she was back to work full time; at three months postop, Jones was totally recovered with no limitations on physical activities. She was glad to get back to her boxing and kick-boxing workouts, beating on the heavy bag for fitness and stress relief. Every weekend she and her family are doing something outdoors together, whether it’s hiking, going to the beach or attending one of her children’s sports activities. According to the National Institutes of Health, aortic dissection can affect anyone, but it’s most often seen in men ages 40 to 70. Jones was a healthy, 38-year-old woman with no family history of heart issues. “Everyone says I’m a miracle,” Jones explains. “I hope my story helps others know to listen to their bodies.”
reasons to choose Adventist Health Castle BY MELE POCHEREVA
WHETHER YOU ARE LOOKING for the right school for your child or buying a car, savvy consumers do their homework before making big decisions. The same is true when choosing where to go for health care services. As a full-service medical center with more than 300 affiliated physicians and a full range of medical and surgical services, Adventist Health Castle is committed to excellence in everything we do. It is our goal to provide our communities with the latest technology and treatments in an environment of compassion, care and respect.
Here are five more reasons to choose AH Castle for your health care needs.
1 High-quality care From patient outcomes and safety to surveys of patient and physician satisfaction, we use performancebased measurements to continuously improve our health care services and facilities to meet the highest standards of quality possible. Castle is among the 85 percent of hospitals across the country that choose to be surveyed every three years by The Joint Commission, a national organization responsible for accrediting hospitals and other health
care organizations based on how well they meet high standards of care. During these surveys, The Joint Commission reviews the quality of staff and equipment, the hospital’s success in treating patients, and makes recommendations on ways to improve health care delivery. Thanks to our 1,300-plus associates and medical providers on staff, Castle earned The Joint Commission’s highest ranking—the Gold Seal of Approval™—following its most recent accreditation survey in 2016.
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With only two recommendations for improvement, it was the most successful accreditation survey to date.
2 Primary care, close to home For Windward O‘ahu residents, greater access to health care tops the list of significant needs identified by the Healthcare Association of Hawai‘i in its most recent Community Health Needs Assessment. Castle has responded by opening four new clinics in Kailua, Kaneohe and Laie and by bringing in more primary
Check out our report card. Find Castle’s annual Quality Reports on our website, in the “About Castle” section.
A second chance at life EVER SINCE she was a teenager, Phyllis O’Donoghue loved to dance and work out at the gym. Seven years ago, in her late 30s, a series of medical conditions and hormonal issues changed that. She gained over 100 pounds in a few months and faced health issues, including uncontrolled diabetes and high blood pressure. The extra weight on O’Donoghue’s already weak knees made it painful even to walk, but O’Donoghue adapted to the pain. “I tried all kinds of treatments, but my weight was stuck at 333 pounds,” she says. O’Donoghue and her husband moved from New Mexico to Hawai‘i in 2016. During their first year here, she tried to lose weight by walking and swimming through the pain and eating healthier, home-cooked meals. She started to feel healthier and stronger, but she was not losing weight. On one of her beach walks, she was encouraged by a woman who’d had weight-loss surgery at Adventist Health Castle. After she attended
care physicians to give these Windward communities convenient, highquality health care. Our clinics offer comprehensive primary care services for children and adults, including immunizations and health screenings. Our newly renovated Castle Professional Center in Kaneohe has primary care providers as well as medical specialists; a pharmacy; and an outpatient services clinic that offers occupational and physical therapy, rehabilitation services, and lab and imaging services.
3 Comprehensive surgical services Over the years, our surgical services have grown to encompass a range of general and specialty surgical procedures, with open-heart surgery and
Before and after: Phyllis O’Donoghue has already lost 100 pounds and can keep up with her granddaughter Rose again.
Castle’s free informational seminar at Kapolei High School, O’Donoghue met with Steven Fowler, MD, a bariatric surgeon and medical director of Castle’s Hawai‘i Center for Metabolic and Bariatric Surgery. Together they agreed that a duodenal switch would be the best procedure, based on her health conditions and weight-loss goals. The procedure creates a smaller stomach pouch and bypasses part of the small intestine.
Immediate results
spine surgery being two of the newest surgical specialties offered at Castle. Three specialized cardiology facilities—the cardiac catheterization lab, hybrid room and cardiovascular operating room—enable Castle’s team of cardiologists and surgeons to perform procedures ranging from cardiac interventions to thoracic and complex open-heart surgeries. Castle has two other well-established multi-specialty surgical programs. The Joint and Spine Center was the first program in the state dedicated to hip and knee replacements when it opened more than 20 years ago. Castle also was the first to invest in robotic
technology. Today, the new, state-ofthe-art NAVIO robotics system assists surgeons with minimally invasive partial knee replacements and total knee replacements. The Center has added specialists in shoulder replacements, sports medicine, hand and microsurgery procedures, and is the state’s most comprehensive spine surgery program, including artificial disc replacement. Also the first of its kind in the state when it opened in 2006, the Hawai‘i Center for Metabolic and Bariatric Surgery is a multidisciplinary program
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O’Donoghue had the surgery in 2017, a few days before Christmas. “Right after my surgery I saw changes,” she recalls. Walking was no longer painful, her diabetes was gone, and her hormones and high blood pressure were under control. It took O’Donoghue a few months to get used to her new food regimen, but during that time she lost 100 pounds and returned to her favorite activities:
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cycling, swimming, dancing and keeping up with her two granddaughters. She feels like herself again. “I love everything about Castle’s program,” she explains. “No matter what you need, they have the resources and ongoing support when you need it.” O’Donoghue says she is grateful for Castle and Dr. Fowler. “I can say without a doubt, they saved my life. They gave me more time with my husband and my family.”
How do you measure a hospital? To help you make the best choice for your care, consider these questions: Does it meet national quality standards? How does it review and improve on its quality of care? How do its services rate with consumer or other groups? Does it accept your health insurance plan? Does it have experience with the type of service or treatment you are seeking? W hat kind of specialty services are available, if needed? Does it offer a convenient location or locations?
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Living a new best life BETTY GERLOFF had already been diagnosed with osteoarthritis in her knees when she was diagnosed with rheumatoid arthritis 10 years ago, at age 55. For years she put off seeing a doctor about relief for her knee pain. “I thought it was just the natural signs of aging, and I would have to do the best I could with the pain,” Gerloff recalls. Daily life was a struggle. “I tried all kinds of knee wraps, gimmicky things you see on TV, over-the-counter treatments, steroid injections and extra-strength pain relievers, but they only gave me temporary relief,” she says. Gerloff had to give up gym workouts and quit her work as a realtor. Walking up stairs was painful; traveling on a plane was out of the
question. Even getting out socially was an effort. Eventually, her periodic X-rays showed her knee joints were worn down to bone on bone. “I’m a very spiritual person, and I feel that Castle sits on healing grounds,” she explains. “It’s an incredible hospital with incredible people.” But part of her was afraid of knee surgery.
Dramatic improvement After attending one of Castle’s free seminars on knee replacements and hearing other patients talk about their experiences, Gerloff made an appointment with Linda Rasmussen, MD, an orthopaedic surgeon with Castle’s Joint and Spine Center. “Once she had examined me, Dr. Rasmussen held out her arms and gave me one of the warmest, most sincere hugs,” Gerloff says. In November 2017, Gerloff had her left knee replaced. Five weeks later she went back to have her right knee replaced. She describes her stay at
reasons to choose Adventist Health Castle —Continued from previous page that has an array of surgical options for weight loss and metabolic disease, accompanied by comprehensive support services to ensure long-term success. Employing best practices standards and the newest technologies, the center is designated a Metabolic and Bariatric Surgery Accreditation Quality Improvement Program.
4 Physician satisfaction When it comes to “quality of care” and “place to practice medicine,” our 300-plus affiliated physicians give Castle high marks. Each June, Castle uses an outside research firm to administer a physician satisfaction survey to our network of
providers that rates 14 service areas within the hospital and gauges their overall perception. The survey also probes physicians’ level of engagement. Engaged doctors value the open communications and team effort to ensure excellent care and patient safety.
5 Nationally recognized excellence In April, Castle’s leadership team traveled to Baltimore, Maryland, to receive the Malcolm Baldrige National Quality Award—the highest national recognition for performance excellence that a U.S. organization can receive. Castle is the first in Hawai‘i— and the first Adventist health care organization—to earn this recognition, which is based on comprehensive performance assessments and
exceptional practices in five key areas: product and process outcomes, customer outcomes, workforce outcomes, leadership and governance, and financial and market outcomes. While the Baldrige Award is the highest honor Castle has received, we also are proud of the many other national awards we earned recently: Five-Star rating from Centers for Medicare and Medicaid Services. Leapfrog “A” Grade for Patient Safety, Spring 2018. Four Women’s Choice awards. 2017 Outstanding Patient Experience Award. WELCOA Gold Workplace Award. QUEST Award for High-value Health Care. Excellence in Patient Care Award.
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Dig deeper. To learn more about our award-winning care, skilled staff and comprehensive, innovative care, visit us at adventisthealthcastle.org to request a brochure, sign up for health classes and seminars, or request a physician directory.
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Castle as a five-star experience. “The whole joint care team was so positive, so professional, so organized,” she says. “I truly felt like I was the only patient there. The words keep coming to mind: how exceptional the care is at Castle.” Today, at age 65, Gerloff has a new lease on life. People who know her can see the dramatic improvement. She is back at the gym and gets out more with her husband of nearly 41 years. In late April she was looking forward to flying to New York to see her daughter and meeting her future sonin-law for the first time. She sees more travel in her future. “I have this new best life I’m living, and feel like I need to make up for the 10 years I lost,” Gerloff says. She is now among the patients who share their stories at the Joint and Spine Center’s informational seminars. Her message: “We all deserve to live our best life, so don’t put off taking care of the pain.”
Our physician survey
Results 96th percentile as a place to practice medicine Our physicians rated AH Castle at the 96th percentile as an “excellent” place to practice medicine compared with over 350 other hospitals nationally. 96th percentile for quality of care Our physicians also gave “excellent” ratings at the 96th percentile for AH Castle’s quality of care. In addition, 11 of 14 service areas ranked above the 75th percentile, including emergency services, nursing care, patient safety, and surgical services. 99th percentile for engagement Lastly, our physicians reported “high engagement” at the 99th percentile compared to other hospitals in the database.
Take time for yourself with Adventist Health Castle’s health programs. We invite you to register for a health-promoting class or seminar or call for a physician referral. Call 263-5400, or visit our website at adventisthealthcastle.org and click on “Classes and Events.”
IN SICKNESS AND IN HEALTH SEMINARS
CLIP AND SAVE
Second Thursday of each month, 6 to 7 p.m., Adventist Health Castle Wellness & Lifestyle Medicine Center Auditorium These free monthly seminars provide expert health and wellness education from leading health care professionals. Healthy refreshments will be served.
FAMILY
MASSAGE
Take a tour of the birth center, or sign up for classes: Giving Birth at Castle. Lamaze. The Bradley Method. Infant Safety. General Newborn Care. Breastfeeding. Car Seat Safety. Healthy Pregnancy. Visit adventisthealthcastle.org or call 263-5050 for dates and registration.
Relax and rejuvenate! Standard rate: $15 per 15 minutes or $30 per 30 minutes. Punch card: 5 massages for $68. Gift certificates available.
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FITNESS
To schedule your massage, please call the Wellness Center at 263-5050. Castle Wellness Center has two licensed massage therapists, Violet Coito and Carolyn Miyagi. Massages are available during the day Monday through Thursday, and every other Friday.
For information on all fitness classes, call 263-5050 or visit adventisthealthcastle.org.
NAMI
Exercise Classes
July 12 “Imaging and Women’s Health” Tracy Buscher, RT; Jessica Roth, RT, and Lori Okuda, RT The best prevention is early detection. Find out how often you should have a mammogram and why from AH Castle’s mammography team. Learn tips on how you can improve your bone health.
Aug. 9 “When is Opiate Use Effective, Necessary or Unsafe” Michael Jaffe, DO Learn about the strength, benefits and concerns about opiates and other alternatives. Hear about the new regulatory environment regarding opiates.
Sept. 13 “Your End-of-Life Wishes” Sarah Canyon, MD What you need to do and who you need to tell—how to prepare for end of life. Discover what paperwork everyone should have and what it means, such as advanced directives and POLSTs.
Registration and fitness assessment are required. (Medical clearance may be necessary.) Balance Training. Core Conditioning. Functional Fitness. Interval Training. Longer Life. Lunch Crunch. Stretch & Roll.
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July 19: Shoulder Pain and Treatment Options: Thomas Keller, MD Aug. 2: Minimally Invasive Spine Surgery: Will Beringer, DO Sept. 6: Hip and Knee Replacements— Featuring NAVIO: Linda Rasmussen, MD
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Learn from orthopaedic surgeons Linda Rasmussen, MD, and Thomas Keller, MD, about treatments to manage knee, hip and shoulder pain, including surgical and nonsurgical options. Learn treatment options for neck and back pain, including minimally invasive surgical options, from neurosurgeon Will Beringer, DO.
Fourth Tuesday of each month, 5:30 to 7 p.m. Castle Wellness Center Auditorium Free support group for family members and friends who care for loved ones with mental illness. Facilitated by trained and experienced volunteers. For more information about NAMI, please visit nami.org.
SUPPORT GROUPS Free and open to the public. Call 263-5400 or visit adventisthealthcastle.org for details: Alzheimer’s Caregivers. Hospice Hawai‘i. Mama Hui. NAMI. Parkinson’s Disease.
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WEIGHT LOSS
Weight-Loss Surgery Seminars Sessions are held in the Castle Wellness Center Auditorium unless otherwise noted. July 18, 6:30 to 8 p.m. Sept. 12, 6:30 to 8 p.m. Aug. 18, 7 to 8:30 p.m. Learn about AH Castle’s comprehensive Metabolic and Bariatric Surgery Program from bariatric surgeon Steven Fowler, MD, and other bariatric team members. Registration required. Call 263-5400.
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TOBACCO TREATMENT Free counseling by appointment Contact our certified tobacco treatment specialists for one-on-one coaching and expert guidance and to learn about nicotine patches, gums and lozenges—available to eligible participants. Call 263-5050.
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sign up online
adventisthealthcastle.org
EAT WELL FOR LIFE Fourth Thursday of each month, 6 to 7:15 p.m. $12/class per person Castle Wellness Center Auditorium Travel the world of plant-based cuisine. All classes are vegan and are demonstration-style. Generous samples and written recipes are provided. Registration and prepayment are required. Registration deadline is one week prior to class. No refunds. Maximum capacity is 40 participants. Call 263-5050 to register.
July 26 “Castle Associate Favorite Vegetarian Pho” Gordon Au Learn how to serve a tasty vegetarian version of this traditional Vietnamese soup. Great comfort food to entertain your family and friends.
Aug. 23 “Indian Tikka Masala” Hannah Vernon, Homecooked with Love, LLC Traditional Indian tikka masala made with a homemade curry paste, coconut cream and locally sourced veggies. This dish is served with a slightly spicy cilantro chutney, homemade gluten-free garlic naan that you can make at home, and light basmati rice.
Sept. 27 “Healthy, Tasty Breakfasts for Busy People” Todd Reese Join Adventist Health Castle Director of Human Performance Todd Reese for a protein-rich waffle, a traditional Swiss Bircher muesli and another vegan breakfast selection.
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640 Ulukahiki St. Kailua, HI 96734
2017 Baldrige Award Winners from left: Darren Atteberry, City Manager, City of Fort Collins (nonprofit); Katherine Gottlieb, President and CEO, Southcentral Foundation (health care); Celeste Ford, CEO and Founder, Stellar Solutions (small business); Kathy Raethel, President, Adventist Health Castle (health care); and R. Michael Browder, CEO, Bristol Tennessee Essential Services (small business).
MALCOLM BALDRIGE NATIONAL QUALITY AWARD
‘Best of the best’ Adventist Health Castle was presented with the Malcolm Baldrige National Quality Award trophy, at the Malcolm Baldrige Quest for Excellence Conference in Baltimore, Maryland. The award ceremony included an acceptance speech by Kathy Raethel, AH Castle president. In her speech, Raethel compared our Baldrige journey to climbing a mountain together with all Castle associates, physicians, and volunteers, and closed by stating the view from the summit is extraordinary.
Sharing our skills In addition to the award ceremony, AH Castle and the other four award recipients shared their quality journeys and exceptional performance practices during the Quest for Excellence Conference. AH Castle held two plenary presentations on the topics of leadership and future focus and seven very popular breakout sessions on the topics of strategy; customers; workforce; operations; and measurement, analysis and knowledge management.
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Harry & Jeanette Weinberg Medical Plaza & Wellness Center
Email us: Visit adventisthealthcastle.org, and click on “Contact Us.” We’d be happy to hear from you! Send us a comment. Request an AH Castle brochure. Request a physician directory.
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2017 Malcolm Baldrige National Quality Award presentation (from left): Robert Fangmeyer, Director, Baldrige Performance Excellence Program; George Benson, Chairman of Foundation for the Malcolm Baldrige National Quality Award; Kathy Raethel, President, and Steve Bovey, Quality Supervisor, Adventist Health Castle; and Walter G. Copan, Under Secretary of Commerce for Standards and Technology and National Institute of Standards and Technology (NIST) Director.
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[email protected]. WINDWARD HEALTH is published quarterly as a community service for the friends and patrons of ADVENTIST HEALTH CASTLE, 640 Ulukahiki St., Kailua, HI 96734, telephone: 808-263-5163, website: adventisthealthcastle.org.
Information in WINDWARD HEALTH comes from a wide range of medical experts. If you have any concerns or questions about specific content that may affect your health, please contact your health care provider.
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